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Videos in Clinical Medicine: Intranasal Naloxone Administration

Rafael Ortega, M.D., Ala Nozari, M.D., Ph.D., William Baker, M.D., Sannoor Surani, M.D., and Melinda Edwards, M.D.
N Engl J Med 2021; 384:e44, March 25, 2021, DOI: 10.1056/NEJMvcm2020745

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USA. Harm Reduction at Sea: Tight-Knit Fishing Communities Navigate Drugs

The setting sun shines a crown of pink light through the windows of a loud bar on the Massachusetts coast, packed with fishermen. It’s 3:30 pm—the end of a long day that began well before dawn. The weight of wear and tear on exhausted muscles and minds is as palpable as the bursts of deep belly laughter and the smell of sweat. Johnnie*, a salt-and-pepper fisherman in his late 50s, is smiling as he tells me what happened one dark night last year.

“It was like a movie star, dropping down from the sky off the helicopter to get to my crewmate, pitch of night,” he says. “The Coast Guard—this handsome guy, my wife would’ve loved him, like Rock Hudson—dropped down from the moon. Felt like hours after we had given him all the Narcan we had. The Coast Guard still didn’t carry it back then, did you know that? So they pulled him up into the clouds and we all were left below at sea.”

“It’s not the first time that’s happened on our boat,” Johnnie says. “If we didn’t have that Narcan on board though, kid probably wouldn’t have made it.” (Filter Mag, USA. 08.04.2021)


Take-home naloxone programs for suspected opioid overdose in community settings: a scoping umbrella review. 

Moustaqim-Barrette A, Dhillon D, Ng J, Sundvick K, Ali F, Elton-Marshall T, Leece P, Rittenbach K, Ferguson M, Buxton JA. 

BMC Public Health. 2021 Mar 26;21(1):597. doi: 10.1186/s12889-021-10497-2. PMID: 33771150; PMCID: PMC8004425.


"They're not doing enough.": women's experiences with opioids and naloxone in Toronto. 

Macleod ER, Tajbakhsh I, Hamilton-Wright S, Laliberte N, Wiese JL, Matheson FI. 

Subst Abuse Treat Prev Policy. 2021 Mar 20;16(1):26. doi: 10.1186/s13011-021-00360-3. PMID: 33743756; PMCID: PMC7980746.


Naloxone-Induced Acute Pulmonary Edema is Dose-Dependent: A Case Series. 

Al-Azzawi M, Alshami A, Douedi S, Al-Taei M, Alsaoudi G, Costanzo E. 

Am J Case Rep. 2021 Mar 17;22:e929412. doi: 10.12659/AJCR.929412. PMID: 33730013; PMCID: PMC7983320.


USA. AMA, State Medical Associations, Oppose Bills Pushing Coprescription of Opioids and Naloxone

North and South Carolina lawmakers are considering bills that would require clinicians to coprescribe naloxone for patients who are prescribed opioids. However, the American Medical Association (AMA) and both states' medical associations oppose the legislation. (Medscape, 22.03.2021)


Schottland. Police Scotland officers administer Naloxone for first time in pilot project

Police Scotland officers have administered Naloxone for the first time, within two hours of receiving training in the use of the spray to reverse an opioid-related drug overdose. (Police Scotland, 08.03.2021)


Naloxone induced pulmonary edema. 

Elkattawy S, Alyacoub R, Ejikeme C, Noori MAM, Remolina C. 

J Community Hosp Intern Med Perspect. 2021 Jan 26;11(1):139-142. doi: 10.1080/20009666.2020.1854417. PMID: 33552437; PMCID: PMC7850343.


First Aid Education for Opioid Overdose Poisoning: Scoping Review. 

Pellegrino JL, Krob JL, Orkin A. 

Cureus. 2021 Jan 3;13(1):e12454. doi: 10.7759/cureus.12454. PMID: 33552772; PMCID: PMC7854333.


A qualitative study of a publicly funded pharmacy-dispensed naloxone program. 

Antoniou T, Pritlove C, Shearer D, Martins D, Tadrous M, Munro C, Gomes T. 

Int J Drug Policy. 2021 Feb 7:103146. doi: 10.1016/j.drugpo.2021.103146. Epub ahead of print. PMID: 33568317. 


Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study. 

Bennett AS, Freeman R, Des Jarlais DC, Aronson ID. 

JMIR Form Res. 2020 Dec 23;4(12):e22411. doi: 10.2196/22411. PMID: 33355094; PMCID: PMC7787889.


The status of naloxone in community pharmacies across Canada. 

So R, Al Hamarneh Y, Barnes M, Beazely MA, Boivin M, Laroche J, Patel H, Sihota A, Smith T, Tsuyuki RT. 

Can Pharm J (Ott). 2020 Sep 21;153(6):352-356. doi: 10.1177/1715163520958435. PMID: 33282025; PMCID: PMC7689620.


Canadian national consensus guidelines for naloxone prescribing by pharmacists. 

Tsuyuki RT, Arora V, Barnes M, Beazely MA, Boivin M, Christofides A, Patel H, Laroche J, Sihota A, So R. 

Can Pharm J (Ott). 2020 Aug 26;153(6):347-351. doi: 10.1177/1715163520949973. PMID: 33282024; PMCID: PMC7689616.


Considering the Potential Benefits of Over-the-Counter Naloxone. 

Evoy KE, Hill LG, Davis CS. 

Integr Pharm Res Pract. 2021;10:13-21, doi.org/10.2147/IPRP.S244709


Ausschreibung für Modellprojekt zur Durchführung deutschlandweiter qualitätsgesicherter „Take-Home Naloxon Schulungen“ gestartet

Drogenbeauftragte Ludwig: „Naloxon kann Leben retten!“ (drogenbeauftragte.de, 13.01.202)



Öffentliche Ausschreibung: Kon­zep­ti­on, Um­set­zung und Eva­lua­ti­on ei­nes Wis­sen­schaft­li­chen Mo­dell­pro­jekts zur Durch­füh­rung deutsch­land­wei­ter qua­li­täts­ge­si­cher­ter Ta­ke-Ho­me Na­lo­xon Schu­lun­gen

Vergabestelle: Bundesministerium für Gesundheit, Angebotsfrist 05.03.2021


Overdoselifesavers.org: a mixed-method evaluation of a public information website on experiences of overdose and using take-home naloxone to save lives,

Adrian Farrugia, Carla Treloar & Suzanne Fraser (2021)

Drugs: Education, Prevention and Policy, DOI: 10.1080/09687637.2020.1858758


Impact of policy changes on the provision of naloxone by pharmacies in Ontario, Canada: a population‐based time–series analysis. 

Antoniou, T., Martins, D., Campbell, T., Tadrous, M., Munro, C., Leece, P., Mamdani, M., Juurlink, D. N., and Gomes, T. (2020) 

Addiction, doi.org/10.1111/add.15324.


NYC Revamps Pharmacies’ Role in Preventing Overdose Deaths

New York City, like the rest of the country, is facing a historic overdose crisis driven by illicit fentanyl adulterating the unregulated drug supply and exacerbated by the COVID-19 pandemic. In response, the city’s health department has made naloxone, the overdose-reversal medication, available free-of-charge at chain pharmacies in highly impacted neighborhoods from which the city has historically divested. (Filter Magazine, USA, 06.01.2021)


Schottland. Take-home Naloxone to save lives.

Take-home Naloxone will be given to people at high risk of accidental overdoses, in a move designed to reduce the number of drug deaths.  This will include those who have been resuscitated by the Scottish Ambulance Service (SAS) following an accidental overdose. (Scottish Government, 06.01.2021)


NTNU intranasal naloxone trial (NINA-1) study protocol for a double-blind, double-dummy, non-inferiority randomised controlled trial comparing intranasal 1.4 mg to intramuscular 0.8 mg naloxone for prehospital use. 

Skulberg AK, Tylleskär I, Braarud AC, Dale J, Heyerdahl F, Mellesmo S, Valberg M, Dale O. 

BMJ Open. 2020 Nov 12;10(11):e041556. doi: 10.1136/bmjopen-2020-041556. PMID: 33184084; PMCID: PMC7662429.


Schottland. Naloxone: Police to carry emergency drug overdose spray

An emergency antidote to treat drug overdose victims will be carried by police officers in Scotland as part of a pilot project.

The nasal spray Naloxone counters the effects of overdoses from opioids such as heroin. (BBC, UK, 18.11.2020)


Naloxon-Nasenspray kann bei Überdosierungen Leben retten

Regensburg/Berlin – Im vergangenen Jahr sind 650 Menschen in Deutschland an einer Opioidvergiftung gestorben. Schätzungen zufolge sind bei Überdosierungen in zwei von drei Fällen jedoch andere Personen anwesend, die mit dem Nasenspray Naloxon helfen könnten und helfen wollen. (aerzteblatt.de, 19.11.2020)


USA. find naloxone near you

The Naloxone Finder is intended for people who use drugs to access naloxone in their community. (National Harm Reduction Coalition, USA, November 2020)


The PLOS ONE Staff (2020) Correction: Higher naloxone dosing in a quantitative systems pharmacology model that predicts naloxone-fentanyl competition at the opioid mu receptor level. 

PLoS ONE 15(9): e0240148. doi.org/10.1371/journal.pone.0240148


A qualitative study of repeat naloxone administrations during opioid overdose intervention by people who use opioids in New York City.

Stephen Parkin, Joanne Neale, Caral Brown, Jermaine D. Jones, Laura Brandt, Felipe Castillo, Aimee N.C. Campbell, JohnStrang, Sandra D.Comer

International Journal of Drug Policy, Volume 87, January 2021, 102968, doi.org/10.1016/j.drugpo.2020.102968


USA. At least 10 times a day, someone on the brink of death from a drug overdose is saved in S.F.

At least 10 times a day, someone on the brink of death from a drug overdose is saved in San Francisco, according to new data provided to The Chronicle.

And that’s likely a massive undercount.

San Francisco’s drug epidemic has skyrocketed this year, claiming about 470 lives in just the first eight months of the year, according to preliminary data from the medical examiner. In a similar time period, at least 2,155 potentially fatal overdoses were prevented by the opioid reversal medication Narcan, which is commonly sprayed up the nose. (San Francisco Chronicle, USA, 15.10.2020)


Evaluation of a personally-tailored opioid overdose prevention education and naloxone distribution intervention to promote harm reduction and treatment readiness in individuals actively using illicit opioids. 

Winhusen T, Wilder C, Lyons MS, Theobald J, Kropp F, Lewis D. 

Drug Alcohol Depend. 2020 Aug 31;216:108265. doi: 10.1016/j.drugalcdep.2020.108265. Epub ahead of print. PMID: 32919098; PMCID: PMC7458095.


Accessing Take-Home Naloxone in British Columbia and the role of community pharmacies: Results from the analysis of administrative data. 

Moustaqim-Barrette A, Papamihali K, Mamdani Z, Williams S, Buxton JA (2020) 

PLoS ONE 15(9): e0238618. https://doi.org/10.1371/journal.pone.0238618


Prehospital naloxone administration - what influences choice of dose and route of administration? 

Tylleskar I, Gjersing L, Bjørnsen LP, Braarud AC, Heyerdahl F, Dale O, Skulberg AK. 

BMC Emerg Med. 2020 Sep 5;20(1):71. doi: 10.1186/s12873-020-00366-3. PMID: 32891142; PMCID: PMC7487505.